The effects of L-arginine (L-Arg), the physiological NO precureor and NO synthetase inhibitor NG-nitro-L-arginine (L-NNA) on endogenous endothelin (ET) secretion and renal function were observed in a model of glycerol-induced acute renal failure (ARF) in rat. It was found that endogenous ET secretion was significantly increased, while serum NO was markedly decreased in ARF rats. The administration of L-NNA to the ARF rats induced significant increases in plasma ET and positive immunoreactive particles of ET in renal tubular epithelial cells(EP cells), and the impairment of renal function was exaggerated. L-Arg might effectively decrease the level of plasma ET and the positive immunoreactive particles of ET in renal tubular EP cells, suggesting the improvement of the renal function. It is suggested that the ability of NO in improving renal function may relatedto the inhibition of endogenous ET secretion in glycerol-induced ARF rats.

Primary duodenal adenocarcinoma (PDA)is a rare but aggressive digestive tract malignancy,and its incidence is increasing in recent years. Early diagnosis of PDA is challenging due to nonspecific symptoms. Hence,it is often detected at an advanced stage. Treatment strategies tends to favor aggressive surgical resection. Adjuvant chemotherapy and radiation are important components of multi-modality treatment for patients with high risk of recurrence, and molecular targeted therapy is still in the exploratory stage. The best adjuvant therapy after operation is not yet clear. Early diagnosis and treatment is of great significance for prognosis. This article reviewed advances in epidemiology,risk factors,diagnosis,treatment and prognosis of PDA.

Objective:To explore the current situation of evidence-based practice competence of nurses with master's degree at Class Ⅲ hospitals in Henan Province and its influencing factors so as to provide a reference for managers to formulate the targeted continuing education plan.Methods:From March 2019 to April 2019, we selected 133 nurses with master's degree of 6 ClassⅢ hospitals in Zhengzhou City of Henan Province as subjects by purposive sampling. All of nurses were investigated with the Chinese version of Evidence Based Practice Evaluation Competence Questionnaire (EBP-COQ) and the Barriers to Research Utilization Scale. Multiple linear regression was used to analyze the influencing factors.Results:Among 133 nurses with master's degree, the total scores of the EBP-COQ and the Barriers to Research Utilization Scale were (98.57±11.01) and (79.66±20.46) respectively. Multiple linear regression analysis showed that the influencing factors of evidence-based practice competence of nurses with master's degree included the working lives, positional titles, attending evidence-based nursing training, awareness to evidence-based practice, accessibility of research funding and resource conditions of evidence-based nursing ( P<0.05) . Conclusions:Nurses with master's degree in Henan Province have the intermediate level of evidence-based practice competence and positive attitudes to evidence-based practice, but their evidence-based knowledge and skills need to be improved. Nursing managers should pay more attention to evidence-based practice competence training of nurses with master's degree, provide many supportive resources and environments, promote evidence-based practice skills training so as to boost the development of specialist nursing practice.

Objective To assess the association between the concentration of the air pollutant PM2.5 and daily outpatient visits for respiratory disease. Methods All records of daily outpatient visits to three hospitals in Shenzhen from January 1 to December 31, 2013 were collected. Daily air pollution monitoring and meteorology data from the same period were also collected in Shenzhen. The data were analyzed using a semiparametric generalized additive model with Poisson distribution of time series analysis controlling for long-term and seasonal trends, flu, DOW, public holidays, and meteorological factors. The excess risk (ER) of respiratory disease and its 95%CI value were calculated, along with the incremental increase of 10 μg/m3 in PM2.5 concentration. Results Number of outpatient visits for respiratory diseases totaled 1 428 672 (daily range:1 790-5 228). The annual average PM2.5 concentration was 40.2μg/m3 (daily range:7.2-137.1μg/m3). The lag1 factor had the most significant impact on the lag effect. We estimated that a 10 μg/m3 increase in day-before PM2.5 concentration was associated with a 1.809% (95% CI:1.709%-1.909%) ER of visits for respiratory disease. After controlling for other pollutants (NO2, CO, and O3), the effect remained stable. When NO2, CO, and O3 were introduced separately, for every 10μg/m3 rise in PM2.5 concentration, the excess risk of daily outpatient visits for respiratory disease was 1.814% (95% CI:1.706%-1.923%), 2.780% (95% CI: 2.668%-2.892%), and 1.513% (95% CI: 1.403%-1.624%), respectively. With simultaneous control of NO2 and O3, NO2 and CO, and CO and O3, for every 10μg/m3 rise in PM2.5 concentration, the excess risk of respiratory disease was 1.369% (95% CI: 1.242%-1.497%), 2.709% (95% CI: 2.590%- 2.828% ), and 2.577% (95% CI: 2.452%- 2.702% ), respectively. With simultaneous control of NO2, CO, and O3, for every 10μg/m3 rise in PM2.5 concentration, the excess risk of respiratory disease was 2.370% (95% CI: 2.231%-2.509%). Conclusions PM2.5 can increase the risk of outpatient visits for respiratory disease in Shenzhen.

Objective To assess the association between the concentration of the air pollutant PM2.5 and daily outpatient visits for respiratory disease. Methods All records of daily outpatient visits to three hospitals in Shenzhen from January 1 to December 31, 2013 were collected. Daily air pollution monitoring and meteorology data from the same period were also collected in Shenzhen. The data were analyzed using a semiparametric generalized additive model with Poisson distribution of time series analysis controlling for long-term and seasonal trends, flu, DOW, public holidays, and meteorological factors. The excess risk (ER) of respiratory disease and its 95%CI value were calculated, along with the incremental increase of 10 μg/m3 in PM2.5 concentration. Results Number of outpatient visits for respiratory diseases totaled 1 428 672 (daily range:1 790-5 228). The annual average PM2.5 concentration was 40.2μg/m3 (daily range:7.2-137.1μg/m3). The lag1 factor had the most significant impact on the lag effect. We estimated that a 10 μg/m3 increase in day-before PM2.5 concentration was associated with a 1.809% (95% CI:1.709%-1.909%) ER of visits for respiratory disease. After controlling for other pollutants (NO2, CO, and O3), the effect remained stable. When NO2, CO, and O3 were introduced separately, for every 10μg/m3 rise in PM2.5 concentration, the excess risk of daily outpatient visits for respiratory disease was 1.814% (95% CI:1.706%-1.923%), 2.780% (95% CI: 2.668%-2.892%), and 1.513% (95% CI: 1.403%-1.624%), respectively. With simultaneous control of NO2 and O3, NO2 and CO, and CO and O3, for every 10μg/m3 rise in PM2.5 concentration, the excess risk of respiratory disease was 1.369% (95% CI: 1.242%-1.497%), 2.709% (95% CI: 2.590%- 2.828% ), and 2.577% (95% CI: 2.452%- 2.702% ), respectively. With simultaneous control of NO2, CO, and O3, for every 10μg/m3 rise in PM2.5 concentration, the excess risk of respiratory disease was 2.370% (95% CI: 2.231%-2.509%). Conclusions PM2.5 can increase the risk of outpatient visits for respiratory disease in Shenzhen.

Objective: To investigate the clinical features and prognostic factors of gastric cancer patients under the age of 40. Methods : The clinical data of 126 young gastric cancer patients under the age of 40 were retrospectively analyzed. Log⁃Rank test and Cox regression model were used to analyze prognostic risk factors ,respectively. Results: The average age of gastric cancer patients in our group was 33. 6 years ,and there were more female patients than male patients(female ∶ male = 1. 25 ∶ 1) , Upper abdominal pain and fullness discomfort were the most common clinical manifestations ,and the predominant sites were gastric antrum angle (43. 7% ) and gastric body (42. 9% ) . Lauren type was mainly diffuse type (89. 7% ) , Nakamura type was mainly undifferentiated type (91. 3% ) , and WHO type was the most common type of low⁃adherence carcinoma (46. 8% ) . 71. 4% of patients were diagnosed with advanced 46. 7% , respectively. The results of univariate analysis showed that the levels of serum CA199 ,tumor length ,depth of tumor invasion ,lymphatic metastasis ,vascular invasion ,and surgical approach were risk factors affecting the prognosis of patients. Multivariate analysis revealed that the levels of serum CA199 ,the depth of tumor invasion and surgical approach were independent prognostic factors. Conclusion Young gastric cancer has a high degree of malignancy and strong biological invasiveness. Most patients are diagnosed at the advanced stage of the tumor,and the overall prognosis is poor. The levels of serum CA199 ,the depth of tumor invasion and surgical approach were independent prognostic factors.